Healthcare Provider Details

I. General information

NPI: 1174520811
Provider Name (Legal Business Name): WILLIAM F HERHOLTZ III AU.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 10/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1396 S 21ST ST
COLORADO SPRINGS CO
80904-4261
US

IV. Provider business mailing address

1396 S 21ST ST
COLORADO SPRINGS CO
80904-4261
US

V. Phone/Fax

Practice location:
  • Phone: 719-520-3311
  • Fax: 719-471-2823
Mailing address:
  • Phone: 719-520-3311
  • Fax: 719-471-2823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number249
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: